Biofeedback Practice Research Articles

Daily heart rate variability biofeedback practice sessions affect plasma Αβ40 and Αβ42 levels in healthy younger and older adults: A randomized clinical trial (N = 108)

AbstractBackgroundGenetic mutations affecting β‐amyloid (Αβ) production suggest that decreasing Αβ levels in healthy adults could prevent AD. However, evidence for behavioral interventions that decrease Αβ levels is lacking. The current study examined whether heart rate variability (HRV) biofeedback affects plasma Αβ levels. This intervention involves breathing slowly at a pace that maximizes the amplitude of heart rate oscillations. During slow paced breathing, the vagus nerve receives strong signals from stretch receptors in blood vessels and the lungs. These afferent signals stimulate ascending vagus nerve signaling that activate ‘safety’ signaling pathways, suppressing stress and arousal pathways in the brain and body. Experiencing adversity increases production of Aβ and risk of AD. We hypothesized that, in healthy adults, daily sessions involving slow paced breathing during HRV biofeedback could decrease Aβ by suppressing these adversity‐related processes.MethodHealthy adults (N = 54 age 18‐35; N = 54 age 55‐80) practiced HRV biofeedback daily for five weeks. They were randomized to use slow paced breathing and HRV biofeedback to increase heart rate oscillations (Osc+ condition) or to use personalized strategies and HRV biofeedback to try to decrease heart rate oscillations (Osc‐ condition). Pre‐ and post‐intervention plasma Aβ40 and Aβ42 levels were quantified blind to condition. Gene expression analysis of peripheral blood samples of the 54 younger adults using bioinformatics‐based analyses of genome‐wide RNA profiles examined activity of pro‐inflammatory, neuroendocrine, and antiviral transcription control pathways relevant to the conserved transcriptional response to adversity (CTRA). We predicted that reductions in the CTRA across the 5‐week trial would be associated with reduced plasma Aβ.ResultBoth younger and older adults showed significant differences between Osc+ and Osc‐ conditions in change in plasma Aβ40 and Aβ42 levels (Figure 1). The Osc+ condition decreased Αβ while the Osc‐ condition increased Αβ. Individual changes in plasma Aβ from pre‐ to post‐intervention were associated with changes in expression of the CTRA in the predicted direction.ConclusionHRV biofeedback affects plasma Aβ and these effects are associated with changes in expression of genes upregulated during adversity. Future longer‐term studies should test whether reducing plasma Αβ via the Osc+ intervention reduces risk of developing AD.

Special Issue: Empirically Supported Protocols in Biofeedback Practice II

Special Issue: Empirically Supported Protocols in Biofeedback Practice II

Special Issue: Empirically Supported Protocols for Biofeedback Practice I

Special Issue: Empirically Supported Protocols for Biofeedback Practice I

Special Issue: Mindfulness, Compassion, and Biofeedback Practice

Special Issue: Mindfulness, Compassion, and Biofeedback Practice

バイオフィードバックに必要な心身医学エッセンス(医学系,BF講座)

バイオフィードバックに必要な心身医学エッセンス(医学系,BF講座)

バイオフィードバックに必要な心理学エッセンス(心理学系,BF講座)

バイオフィードバックに必要な心理学エッセンス(心理学系,BF講座)

Special Issue: Mindfulness and Compassion in Biofeedback Practice

Special Issue: Mindfulness and Compassion in Biofeedback Practice

A Guide to Cleaner Skin Temperature Recordings and More Versatile Use of Your Thermistor

Valid peripheral temperature measurements ensure the integrity of client assessment and biofeedback training. Accurate measurements require understanding of the signal and potential influences on measurement fidelity, and developing bulletproof monitoring procedures. In addition to their use in temperature biofeedback, thermistors can assist heart rate variability biofeedback practice and monitor breathing when a respirometer is not available.

Mindfulness, Acceptance, and Compassion in Biofeedback Practice

The cover of this issue of Biofeedback shows a photograph reflecting the mindfulness theme of this special issue. Thanks to Shutterstock for the use of this photo.

Implementing Heart Rate Variability Biofeedback Groups for Veterans with Posttraumatic Stress Disorder

This article describes the administration of a heart rate variability (HRV) biofeedback intervention designed to reduce posttraumatic stress disorder (PTSD) severity in post-9/11 service members. The study recruited 33 male OEF/OIF/OND combat veterans in a Los Angeles transitional housing program. Twenty-seven veterans completed the study. Participants attended eight once-weekly HRV biofeedback group sessions. For the first four weeks, veterans learned to use biofeedback to regulate physiological stress responses. The latter four weeks consisted of real-life biofeedback application and coaching. Results suggest that consistent HRV biofeedback practice was essential for HRV improvement, which may help alleviate PTSD.

The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.

<i>The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness.</i>

Who Are We and What Are We Doing? A Survey of Biofeedback Professionals Working with Children

This article sought to understand the current training and activities of professionals providing biofeedback to children, via an anonymous survey administered though professional organization listservs. Based on 57 responders, we identified gaps in training and in the use of evidence-based interventions. However, these responders are communicating primarily with other biofeedback practitioners. The vast majority are not active in biofeedback research on children. We conclude by raising several questions for professionals and professional organizations to consider regarding the specialized training and evidence-based practice of biofeedback.

What Is BCIA Really?

The Biofeedback Certification International Alliance (BCIA) is the primary international certification body in the fields of biofeedback and neurofeedback, including pelvic floor muscle dysfunction biofeedback. BCIA has established blueprints of knowledge and requirements for independent practice to guide the process of education and training in the three fields of biofeedback, neurofeedback, and pelvic floor muscle dysfunction biofeedback. BCIA promotes certification globally to ensure consistent standards and quality in the practice of biofeedback and neurofeedback.

Editor's Introduction: Winter Issue 2012

The cover of this Winter 2012 issue of Biofeedback shows a woman in a biofeedback session, displaying a pulse oximeter on her left hand. An article in this issue, by Christopher Gilbert, PhD, introduces the use of the pulse oximeter in clinical biofeedback practice. Our thanks to the photographer, Eric Willmarth, PhD, and the model, Tonya Jackson, for this photograph.Fred Shaffer, Judy Crawford, and Donald Moss provide an article reviewing the expanded role of the Biofeedback Certification International Alliance (BCIA) in global biofeedback and neurofeedback certification. The BCIA mission is as follows: “BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback, and progressively recertifies those who advance their knowledge through continuing education.” The BCIA provides a number of supports for professional education, including a “blueprint of knowledge” describing essential knowledge in each certification area, guidelines for a mentoring process assuring that certified practitioners will possess a basic repertoire of skills, and an expanding number of webinars on topics in biofeedback and neurofeedback.Christopher Gilbert provides an article on the use of the pulse oximeter in breath training. A pulse oximeter measures the level of oxygen in the bloodstream, using a noninvasive and inexpensive sensor applied to the finger or earlobe. The oximeter uses photoplethysmography, which is an infrared sensor to measure oxygen saturation in the bloodstream, as well as current heart rate. Gilbert overviews the physiology of breathing and oxygen saturation, and describes how the oximeter can be used as an educational tool and as a safety measure.Richard Harvey, Erin Thorne, and Jourdan McPhetridge provide a report on a recent study of “dysponesis awareness training.” Dysponesis is a term first developed by George Whatmore and Daniel Kohli (1968) to describe unnecessary muscular effort that does not contribute functionally to a task. Whatmore and Kohli originally applied this concept to clinical patients suffering pathological pain. The Harvey et al. article utilizes healthy undergraduates and examines how biofeedback can be utilized to enhance awareness and control of misplaced muscle effort, and reduce inefficient muscle use.Leah Lagos, Thomas Bottiglieri, Bronya Vaschillo, and Evgeny Vaschillo provide an introduction to a new application area for heart rate variability (HRV) biofeedback—the treatment of postconcussion syndrome. They review the physiological dysfunction that typically follows a concussion, especially altered autonomic function and impairments in cerebral autoregulation. They examine the known therapeutic effects of HRV training and provide a physiological rationale for clinical trials applying HRV to postconcussion syndrome patients. Lagos and her colleagues will follow up in a future issue of Biofeedback with a case study of a patient with postconcussion syndrome with a positive therapeutic response to HRV training.Erik Peper, Dianne Schumay, and Donald Moss provide a discussion of the importance of a patient's illness beliefs or illness attributions in shaping that patient's willingness to pursue self-regulation oriented treatment programs. Patients who are strongly external in their locus of control and who believe that their illness is curable only by such external interventions as surgery or medication are less likely to undertake treatments based on skill acquisition, lifestyle change, and self-regulation. The authors discuss strategies for the use of both biofeedback and somatic education to increase internal locus of control and to introduce corresponding changes in illness beliefs. A case history illustrates a biofeedback intervention to positively change illness beliefs, and a somatic awareness exercise is used to illustrate a somatic education approach.

BCIA Certification Exams—A New Look at This Standard

For the Biofeedback Certification International Alliance (BCIA), assessment is the culmination of a learning process that begins with didactic training that is guided by Blueprints of Knowledge and Core Reading Lists. The references in the BCIA Core Reading Lists help applicants master the learning objectives of the Blueprint and are the source of the exam questions. BCIA certification exams test entry-level knowledge that is relevant to the current practice of biofeedback. Applicants can now take exams in both paper/pencil and online formats. BCIA encourages applicants to use the Blueprints as roadmaps to guide their study, to read the Core references, and to take advantage of their mentors' experience. The quality of the applicants, the excellence of didactic programs, and the careful construction of the exams have resulted in pass rates that exceed 70%. BCIA believes that the applicant's journey, not passing the certification exam, is the best metric for measuring success. BCIA has achieved its mission in the time before the professionals arrive at their testing site.

Special Issue: Remembering and Honoring Thomas H. Budzynski

The cover of this Winter 2011 issue of Biofeedback shows a photo of Thomas H. Budzynski, a pioneer in both biofeedback and neurofeedback. Tom died February 14, 2011, at the age of 77. Tom was born in Grand Rapids, Michigan, in 1933 and initially pursued a degree in electrical engineering at the University of Detroit. His early engineering career involved cutting-edge aerospace work for Honeywell, including his role in developing the inertial guidance system for the Blackbird spy plane. Fortunately for the field of biofeedback, Tom pursued new directions in the late 1960s, and brought his engineering acumen into the field of psychology. Tom earned a PhD in psychology at the University of Colorado, and the rest is biofeedback history.Tom Budzynski was a pioneer from his graduate student days onward. He produced a prototype surface electromyography biofeedback device, which served as the focus of his doctoral dissertation and his first publication with Johann Stoyva (Budzynski, 1969; Budzynski &amp; Stoyva, 1969). In collaboration with Johann Stoyva and Charles Adler, he developed a protocol for headache treatment (Budzynski, Stoyva, &amp; Adler, 1970). He pioneered many areas of neurofeedback as well. In this special issue, Tom's widow and several close friends and colleagues recall his personality, wit, and gift for pursuing the furthest edge in biofeedback technology and applications.This professional issues section presents an article by Fred Shaffer and Judy Crawford on “savvy marketing strategies” for Biofeedback Certification Institute of America (BCIA) certificants. The authors report increased consumer interest in biofeedback and neurofeedback services, an increase in enrollment in BCIA accredited training programs, and an increase in applications for BCIA's three certification programs. They describe a series of strategies that some BCIA certified biofeedback practitioners are following to promote both their practices and the field of biofeedback.This special issue opens with an article by Tom Budzynski's co-researcher and widow, Helen Kogan Budzynski. Helen narrates Tom's activities in biofeedback during each decade of his professional life: from the 1960s and graduate school; the 1970s during which his electromyographic biofeedback device went into commercial production and during which he introduced the twilight learning process; the 1980s when he began his work with photic and auditory stimulation; the 1990s during which he extended his research on sound and light stimulation into new applications.Next, three of Tom's closest collaborators, Johann Stoyva, Kirk Peffer, and John Picciottino, each share memories of their friendship with Tom, as well as observations of his greatest contributions to biofeedback instrumentation and biofeedback practice principles. Tom combined the gifts of an innovative engineer and inventor, with the business acumen to manufacture and market both biofeedback equipment and therapeutic audio programs, and the curiosity of a scientist intent on understanding the human brain, the human energy field, and the principles of feedback learning.Niels Bierbaumer describes his initial 1971 encounter with Tom's work through an unpublished paper by Tom Budzynski and Johann Stoyva, and the lifelong friendship and collaboration which followed. He honors Tom especially for conceptualizing a psychophysiological foundation for psychotherapy, for developing one of the first useable neurofeedback devices, and for his twilight learning protocol.Tom Allen tells the story of his friendship with Tom, and emphasizes Tom's use of storytelling as a therapeutic tool. He expresses gratitude to Tom for mentoring him in his early work developing the Windows-based Biograph™ software system for multi-modal biofeedback, and for unflagging support throughout the years of their friendship.Robert Austin narrates the two decades of his friendship and collaboration with Tom, including Tom's two years as Director of Research for Austin's company, Synchromed, LLC. He describes Tom's scientific investigation of sound and light stimulation systems, as well as his use of such devices in a clinical context. He also mentioned Tom's “Hemifield” project, and his development of subliminal audio techniques.Richard Williams relates his own experiences with a “guy named Tom.” Williams honors Tom especially for his work on aging and regeneration in the Ponce de Leon Project, and his “brain brightening project.”This issue also includes an essay written by Tom Budzynski, Twilight Learning Revisited, in which he reviews the scientific background from which he developed the twilight learning protocol. He discusses the protocol and compares it to Eugene Peniston's protocol, which was developed for the neurofeedback treatment of substance abuse. This essay is published here with the permission of FutureHealth, which originally included this essay in an e-book. (Our thanks to Rob Kall of FutureHealth.)We also provide a bibliography of the published works of Tom Budzynski. This bibliography is based on Tom's own records, with edits by Helen Budzynski and Donald Moss.

Biofeedback of Heart Rate Variability and Related Physiology: A Critical Review

Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence.

The circle of the soul: the role of spirituality in health care.

This paper examines the critical attitude of behavioral professionals toward spiritual phenomena, and the current growing openness toward a scientific study of spirituality and its effects on health. Health care professionals work amidst sickness and suffering, and become immersed in the struggles of suffering persons for meaning and spiritual direction. Biofeedback and neurofeedback training can facilitate relaxation, mental stillness, and the emergence of spiritual experiences. A growing body of empirical studies documents largely positive effects of religious involvement on health. The effects of religion and spirituality on health are diverse, ranging from such tangible and easily understood phenomena as a reduction of health-risk behaviors in church-goers, to more elusive phenomena such as the distant effects of prayer on health and physiology. Psychophysiological methods may prove useful in identifying specific physiological mechanisms mediating such effects. Spirituality is also a dimension in much of complementary and alternative medicine (CAM), and the CAM arena may offer a window of opportunity for biofeedback practice.

Biofeedback training: offerings, plans, and some attitudes in graduate schools and internships.

Graduate schools and APA-approved internships in North America were surveyed to determine the type and extent of biofeedback training, additional biofeedback training planned, requirements considered to be a minimum necessary before beginning clinical practice of biofeedback, when biofeedback is considered an appropriate application, and whether biofeedback is considered a "passing fad" in clinical practice. Questionnaires were returned by 56% of the graduate schools and 54% of the internships, and revealed training in 58% and 67% respectively. Training in biofeedback procedures appears to be growing, and most graduate schools and internships think that biofeedback is not a passing fad in clinical practice. Training emphases vary considerably across graduate schools and internships, with some schools and internships excluding theory and/or practice and/or research from their instruction. The results are discussed in relation to the question of determining which procedures to include in future instruction.

Quieting response training: long-term evaluation of a clinical biofeedback practice.

Clinical evidence for the long-term effectiveness of biofeedback related relaxation training is accumulating. The purpose of this report is to describe the population, self-regulation procedure, outcome criteria, and final outcome for patients who received Quieting Response (QR) training. Data from 340 patients who completed at least the first follow-up at 3 months is presented. Primary presenting symptoms were headaches, 72%; primary and secondary Raynaud's, 14%; hypertension, 4%; irritable colon, 4%; and miscellaneous, 6%. QR training integrated EMG and thermal feedback with deep breathing, progressive relaxation, and autogenic exercises presented on cassette tapes. Eight 1-hour weekly sessions were given, with emphasis on daily home exercises. Follow-up evaluations were at 3 months, 6 months, 1 year, and 2 years. Outcome was based on change in frequency, severity, and duration of symptoms; changes in medication; and secondary benefits. Quieting Response training was found to be most beneficial for patients with primary Raynaud's disease (18 of 23 patients, or 78% successful), classic migraines (9 of 13, or 69%), and common migraines (20 of 32, or 62%), followed by mixed headaches (79 of 131, or 60%), Raynaud's plus other symptoms (9 of 15, or 60%), and the irritable colon syndrome (7 of 13, or 54%). Less successful were patients with headaches plus other symptoms (16 of 37, or 43%), muscle contraction headaches (13 of 33, or 39%), secondary Raynaud's phenomenon (4 of 10, or 40%), and essential hypertension (5 of 15, or 33%). Speculations about the differing outcomes across symptom groups were made.